Raphael Jean L, Oyeku Suzette O
1Department of Pediatrics, Baylor College of Medicine, Hematology/Oncology, Houston, TX; and.
Hematology Am Soc Hematol Educ Program. 2013;2013:433-8. doi: 10.1182/asheducation-2013.1.433.
Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team-based PCMH care strategies for SCD pain management.
疼痛是镰状细胞病（SCD）住院和急性发病的最常见原因。SCD相关疼痛的后果严重，对个人和医疗保健系统都会产生影响。以患者为中心的医疗之家（PCMH）的出现为将改善SCD管理的努力与创新且可能具有成本效益的以患者为中心的护理模式相结合提供了新机会。美国卫生与公众服务部已将SCD指定为优先领域，重点是为受影响患者创建PCMH。对于患者、临床医生、科学家和政策制定者而言，问题在于如何设计PCMH以解决SCD的标志性特征——疼痛。本文提供了PCMH模式下疼痛管理的框架。我们概述了SCD中的疼痛及疼痛管理、疼痛管理中的差距、患者目前使用的护理模式，并讨论了PCMH的核心概念以及基于多学科团队的PCMH护理策略，用于SCD疼痛管理。
